Rijnstate Hospital

Arnhem, Netherlands

Rijnstate Hospital

Arnhem, Netherlands

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EDINBURGH, Scotland (May 29, 2017) - The International Neuromodulation Society (INS) has selected six best scientific abstracts that represent insights that may facilitate expanded, increasingly tailored care. The winners are being announced May 29 at the INS 13th World Congress in Edinburgh, Scotland. "These accomplishments represent rapid progress in our field, and offer potential to expand and improve patient care," commented INS President Timothy Deer, M.D. "We are proud to acknowledge such stellar and promising research." Neuromodulation entered use in the 1980s to manage chronic pain, treat bladder dysfunction, improve sensory deficits, and limit motor symptoms of movement disorder. The techniques and targets continue to evolve with potential to treat an expanding array of health conditions. The scientific abstracts being recognized reflect the field's overall trends toward personalized care that tailors therapy to address underlying conditions. The abstracts were selected for quality, originality, and ingenuity from among more than 470 accepted abstracts. The abstract competition began in 2015. The six winning research projects represent innovative therapy approaches or basic research, providing knowledge that can improve treatment or help clarify mode of action. New functional treatment for chronic low back pain - Vivek Mehta, MD, FRCA, FFPMRCA, a consultant in Pain Medicine and Neuromodulation; and director, Pain and Anaesthesia Research Centre at St. Bartholomew's Hospital, Barts Health NHS Trust, London, is presenting on behalf of collaborators an innovative neuromodulation treatment option that was demonstrated in 53 patients who have disabling localized chronic lower back pain. These patients had undergone medication and pain interventions without any demonstrable benefit and were not found suitable for spinal surgery. This new treatment stimulates the multifidus muscle, a core muscle group, which causes it to contract, thereby strengthening it and stabilizing the lower back. The method targets functional stability as well as pain. After 90 days of treatment, most participants improved in at least one of three measures - pain, disability, or quality of life. At one year, more than 80 percent of patients expressed satisfaction with the treatment. The study indicated this innovative therapy could be safe and effective option for patients with chronic disabling low back pain who are not suitable candidates for surgery. Earlier in its development, the method was featured four years ago in an Innovations Day panel at the INS 11th World Congress. Stimulation effects on postural instability in Parkinson's disease - Stephanie Tran, a neuroscience master's candidate at the University of British Columbia, submitted results of a study that showed non-invasive galvanic vestibular stimulation improved postural stability in 13 patients with Parkinson's disease, a movement disorder marked by postural instability. The vestibular system is part of the inner ear involved in maintaining balance. Its stimulation had been shown to affect motor responsiveness in individuals with neurodegenerative disease. She tracked patients' degree of sway as they stood with their eyes closed, taking measurements while they were on their normal medication to target treatment-resistant symptoms. She compared two stimulation directions and found stimulation from the middle to side was particularly helpful in the patients. By contrast, the stimulation did not change measurements nine healthy control subjects. She also was a winner in the INS 12th World Congress abstract competition in 2015 for related research. Combined stimulation method for pain control - Eugene Mironer, M.D., managing partner of the Carolinas Center for Advanced Management of Pain in North Carolina and South Carolina, will present results of a comparative prospective study in 40 patients who have lower back or leg pain and received a combination of spinal and peripheral nerve stimulation. Patients were randomly administered three different stimulation interaction patterns for two weeks apiece. He found 82 percent of the patients preferred an interaction in which the spinal cord stimulator had a positive charge and, across the lower back, a peripheral nerve stimulator had a negative charge. The remainder of the patients preferred the reverse polarity. No patients chose the third option, in which the leads were used independently. The patients' preferred spinal-peripheral stimulation supports findings in an earlier study from Neuromodulation: Technology at the Neural Interface that evaluated that configuration. High-frequency spinal cord stimulation for intractable leg pain - Jan Willem Kallewaard, M.D. of Rijnstate Hospital, Arnhem, the Netherlands, is presenting interim results from a prospective multicenter study in 42 pain patients whose intractable leg pain was treated with high-frequency spinal cord stimulation. This method does not produce tingling sensations of paresthesia like conventional spinal cord stimulation. Data are being collected on pain intensity and quality, functionality, quality of life, psychological assessments, opioid usage and return to work. In six-month results, the study showed clinically meaningful improvements in pain scores, disability and catastrophizing. High-frequency stimulation capabilities were the subject of an Innovations Day presentation at the INS 10th World Congress. Preliminary results from a prospective, multicenter study of high-frequency spinal cord stimulation in intractable, painful peripheral polyneuropathy - Sean Li, M.D. will present preliminary results from the first prospective, multicenter clinical study to use high-frequency spinal cord stimulation in patients with painful peripheral polyneuropathy of the arms or legs. At one month, the 16 participants experienced 70.5 percent pain relief overall. Six of the patients had painful diabetic neuropathy, a relatively common complication that is hard to treat. This subgroup experienced 67.5 percent pain relief. Pain-relieving spinal cord stimulation is associated with the activation of progenitor nerve cells - A scientific study by Clinical Associate Professor Chi Wai Cheung, M.D., director of Hong Kong University's Laboratory and Clinical Research Institute for Pain, and his research team provide rare cellular evidence of spinal cord stimulation effects. The study in laboratory rats showed spinal cord stimulation that relieves pain from spinal injury is associated with an increase in neural progenitor cells. About half the progenitor cells carried a marker for GABA-expressing neurons. GABA is a neurotransmitter associated with inhibition of pain signals. Repetitive spinal cord stimulation provided a long-lasting and incremental analgesic effect, based on hypersensitivity results from touching the hind paw with a microfilament. The pain-relieving effect might be associated with increased progenitor cells since many showed characteristics of GABA neurons. This study provides evidence for a central mechanism of pain relief from spinal cord stimulation. All abstracts submissions accepted for presentation at the congress will be published online in the INS journal Neuromodulation: Technology at the Neural Interface. The nonprofit International Neuromodulation Society presents up-to-date information about the full breadth of neuromodulation therapies through an interactive website, its journal Neuromodulation: Technology at the Neural Interface, annual regional meetings, and its biennial world congress. Neuromodulation therapy, sometimes referred to as bioelectric medicine or electroceuticals, is one of medicine's fastest-growing fields, driven by rising neurological disease in an aging population, and the need for non-pharmacological approaches to manage symptoms. The first use of spinal cord stimulation (SCS) to treat chronic pain of neuropathic origin was reported in 1967 by C. Norman Shealy, M.D., Ph.D. Neuromodulation devices, such as SCS and deep brain stimulation systems, leverage technology developed for cardiac pacemakers and cochlear implants to re-balance neural activity. Neuromodulation therapies help relieve chronic pain or restore function. Existing and emerging devices operate through targeted application of electrical, magnetic, chemical, or optical stimulation. Current or emerging neuromodulation therapies address deficits in vision, hearing, breathing, mobility, grasp or gait, motor function, mood, memory, and digestion.


Spanier B.W.M.,Rijnstate Hospital | Bruno M.J.,Erasmus Medical Center | Dijkgraaf M.G.W.,Clinical Research Unit
World Journal of Gastroenterology | Year: 2013

AIM: To analyze trends in incidence and mortality of acute pancreatitis (AP) and chronic pancreatitis (CP) in the Netherlands and for international standard populations. METHODS: A nationwide cohort is identified through record linkage of hospital data for AP and CP, accumulated from three nationwide Dutch registries: the hospital discharge register, the population register, and the death certificate register. Sex- and age-group specific incidence rates of AP and CP are defined for the period 2000-2005 and mortality rates of AP and CP for the period 1995-2005. Additionally, incidence and mortality rates over time are reported for Dutch and international (European and World Health Organization) standard populations. RESULTS: Incidence of AP per 100000 persons per year increased between 2000 and 2005 from 13.2 (95%CI: 12.6-13.8) to 14.7 (95%CI: 14.1-15.3). Incidence of AP for males increased from 13.8 (95%CI: 12.9-14.7) to 15.2 (95%CI: 14.3-16.1), for females from 12.7 (95%CI: 11.9-13.5) to 14.2 (95%CI: 13.4-15.1). Irregular patterns over time emerged for CP. Overall mean incidence per 100000 persons per year was 1.77, for males 2.16, and for females 1.4. Mortality for AP fluctuated during 1995-2005 between 6.9 and 11.7 per million persons per year and was almost similar for males and females. Concerning CP, mortality for males fluctuated between 1.1 (95%CI: 0.6-2.3) and 4.0 (95%CI: 2.8-5.8), for females between 0.7 (95%CI: 0.3-1.6) and 2.0 (95%CI: 1.2-3.2). Incidence and mortality of AP and CP increased markedly with age. Standardized rates were lowest for World Health Organization standard population. CONCLUSION: Incidence of AP steadily increased while incidence of CP fluctuated. Mortality for both AP and CP remained fairly stable. Patient burden and health care costs probably will increase because of an ageing Dutch population. © 2013 Baishideng. All rights reserved.


TODAY (25 November 2016), DURING THE CELEBRATIONS TO MARK THE ANNIVERSARY OF THE UNIVERSITY OF TWENTE’S FOUNDATION DAY (KNOWN AS DIES NATALIS), THE PROFESSOR DE WINTER AWARD WAS PRESENTED TO DR JEANNETTE HOFMEIJER. Enschede, Netherlands, 28-Nov-2016 — /EuropaWire/ — This publication award for especially talented women academics is an acknowledgement of outstanding academic research and intended to boost the recipient’s academic career. The award is being presented for the tenth time this year. Hofmeijer is receiving the award for her article Early EEG contributes to multimodal outcome prediction of postanoxic coma published in the leading scientific journal Neurology. In her research, she shows that using EEG monitoring can radically improve predictions of the outcome of a coma caused by a lack of oxygen in the brain. Using current methods, it is only possible to make a correct estimate quickly and reliably in 10% of patients. If a new method is used – involving continuous EEG monitoring and observing the speed of recovery in brain activity – it is possible in around 50% of cases. Hofmeijer’s study therefore demonstrated that recovery over time is a better indicator of the seriousness of brain damage than one brief measurement at a single time, which is currently standard practice. The Professor De Winter Award judging panel described it as an outstandingly written article, published in a leading journal. The panel also pointed out that Hofmeijer, who combines her work as a neurologist at Rijnstate Hospital in Arnhem with research at the University of Twente, is an ideal connecting link between medical practice and the academic world. “Not only does her research translate fundamental research into medical practice, it also takes a practical problem from clinical practice as its point of departure. This matches perfectly with the mission of the UT’s MIRA research institute, which sees outstanding research and technology as important catalysts for improving healthcare.” After studying Medicine and Philosophy, Hofmeijer specialized as a neurologist and intensive care doctor. She was awarded her doctorate at Utrecht University in 2007. Since 2008, she has worked at Rijnstate Hospital in Arnhem and in the Clinical Neurophysiology department at the University of Twente. Hofmeijer has published more than 75 academic articles. The Professor De Winter Award, named in honour of the professor who died in 2005, is an international publication award for leading women academics. It is an acknowledgement of outstanding academic research and intended to boost the recipient’s academic career. The award, which consists of €2,500 in cash and a certificate, is funded by the Professor De Winter Award fund, a named fund set up in the Twente University Fund. It was partly made possible by a donation from the professor’s widow, who herself died in 2013. After her death, UT alumnus Henk Hoving and his partner Thijs van Reijn decided to continue the annual donation to the University Fund. The award is being presented for the tenth time this year. In addition to the Professor De Winter Award, the Professor De Winter Fund also finances the Professor De Winter Scholarship every year. It is intended for outstanding women students from abroad who study on a Master’s degree programme at the University of Twente. The scholarship, worth € 7,500 per year over a two-year period, was this year awarded to Karen Abeniacar from Italy. She completed her Bachelor’s degree programme in Industrial Engineering at the Turkish Sabancı University. This academic year, she began the Master’s programme in Industrial Engineering and Management at Twente.


Hofmeijer J.,Rijnstate Hospital | Hofmeijer J.,University of Twente | Van Putten M.J.A.M.,Rijnstate Hospital | Van Putten M.J.A.M.,University of Twente
Stroke | Year: 2012

In the human brain, ≈30% of the energy is spent on synaptic transmission. Disappearance of synaptic activity is the earliest consequence of cerebral ischemia. The changes of synaptic function are generally assumed to be reversible and persistent damage is associated with membrane failure and neuronal death. However, there is overwhelming experimental evidence of isolated, but persistent, synaptic failure resulting from mild or moderate cerebral ischemia. Early failure Results from presynaptic damage with impaired transmitter release. Proposed mechanisms include dysfunction of adenosine triphosphate-dependent calcium channels and a disturbed docking of glutamate-containing vesicles resulting from impaired phosphorylation. We review energy distribution among neuronal functions, focusing on energy usage of synaptic transmission. We summarize the effect of ischemia on neurotransmission and the evidence of long-lasting synaptic failure as a cause of persistent symptoms in patients with cerebral ischemia. Finally, we discuss the implications of synaptic failure in the diagnosis of cerebral ischemia, including the limited sensitivity of diffusion-weighted MRI in those cases in which damage is presumably limited to the synapses. © 2011 American Heart Association, Inc.


Janssens P.M.W.,Rijnstate Hospital | Wasser G.,Rijnstate Hospital
Clinical Chemistry and Laboratory Medicine | Year: 2013

Background: Modern computer systems allow limits to be set on the periods allowed for repetitive testing. We investigated a computerised system for managing potentially overtly frequent laboratory testing, calculating the financial savings obtained. Methods: In consultation with hospital physicians, tests were selected for which 'spare periods' (periods during which tests are barred) might be set to control repetitive testing. The tests were selected and spare periods determined based on known analyte variations in health and disease, variety of tissues or cells giving rise to analytes, clinical conditions and rate of change determining analyte levels, frequency with which doctors need information about the analytes and the logistical needs of the clinic. Results: The operation and acceptance of the system was explored with 23 analytes. Frequency filtering was subsequently introduced for 44 tests, each with their own spare periods. The proportion of tests barred was 0.56%, the most frequent of these being for total cholesterol, uric acid and HDL-cholesterol. The financial savings were 0.33% of the costs of all testing, with HbA 1c, HDL-cholesterol and vitamin B12 yielding the largest savings. Following the introduction of the system the number of barred tests ultimately decreased, suggesting accommodation by the test requestors. Conclusions: Managing laboratory testing through computerised limits to prevent overtly frequent testing is feasible. The savings were relatively low, but sustaining the system takes little effort, giving little reason not to apply it. The findings will serve as a basis for improving the system and may guide others in introducing similar systems.


van Lommel P.,Rijnstate Hospital
Annals of the New York Academy of Sciences | Year: 2011

Because the publication of several prospective studies on near-death experience (NDE) in survivors of cardiac arrest have shown strikingly similar results and conclusions, the phenomenon of the NDE can no longer be scientifically ignored. The NDE is an authentic experience that cannot be simply reduced to imagination, fear of death, hallucination, psychosis, the use of drugs, or oxygen deficiency. Patients appear to be permanently changed by an NDE during a cardiac arrest of only some minutes' duration. It is a scientific challenge to discuss new hypotheses that could explain the possibility of a clear and enhanced consciousness-with memories, self-identity, cognition, and emotions-during a period of apparent coma. The current materialistic view of the relationship between consciousness and the brain, as held by most physicians, philosophers, and psychologists, seems to be too restricted for a proper understanding of this phenomenon. There are good reasons to assume that our consciousness, with the continuous experience of self, does not always coincide with the functioning of our brain: enhanced or nonlocal consciousness, with unaltered self-identity, apparently can be experienced independently from the lifeless body. People are convinced that the self they experienced during their NDE is a reality and not an illusion. © 2011 New York Academy of Sciences.


Hofmeijer J.,Rijnstate Hospital
Journal of neurology | Year: 2013

In patients with space-occupying hemispheric infarction, surgical decompression within 48 h after stroke onset increases the chance of a good functional outcome, but also the chance of survival with severe disability. Until now, cognitive outcome in these patients has not been reported in a consecutive series. Participants of the hemicraniectomy after middle cerebral artery infarction with life-threatening edema trial (HAMLET; ISRCTN94237756) underwent detailed neuropsychological examination at a median of 14.5 months after stroke onset. 'Global cognitive impairment' was defined as a score on the Cambridge cognitive examination (CAMCOG) ≤ 83. Impairment on an individual neuropsychological task was defined as a score below the 2.5th percentile or more than two standard deviations below standard norms. The association between cognitive and functional outcome was analysed with linear regression. Twenty patients were tested. Fifteen (75 %) had global cognitive impairment or such poor performance that assessment of global cognitive performance by the CAMCOG was not feasible. Five had only focal cognitive deficits. Still, detailed neuropsychological examination was feasible in 18 patients. Patients with aphasia performed worse than those without on both verbal and non-verbal tasks. Poorer cognitive performance was associated with worse functional outcome as assessed with the modified Rankin scale (β -0.4, 95 % CI -0.6 to -0.1). No differences were observed between operated and non-operated patients. The majority of survivors of space-occupying hemispheric infarction suffered from long-term global cognitive impairment. Isolated focal neuropsychological deficits were found in only a quarter. Impaired cognitive outcome was associated with worse functional outcome.


Janssens P.M.W.,Rijnstate Hospital
Clinica Chimica Acta | Year: 2010

The possibilities for ordering laboratory testing in hospitals inevitably need to be managed, given physicians' knowledge on the use of laboratory testing, their attitudes towards test ordering, the constant increase in testing and the limited resources available. On the assumption that some tests may not be strictly necessary or are even redundant, this paper reviews various methods to manage the demand for laboratory tests, evaluating the extent to which these methods are applicable and effective in daily practice. The most promising new management tools seem to be computerised laboratory management systems (CDSS), a reimbursement system based on the diagnosis-treatment combination (as in The Netherlands), and the allocation of laboratory budget to those requesting laboratory services. © 2010 Elsevier B.V.


Aarts E.O.,Rijnstate Hospital | Janssen I.M.C.,Rijnstate Hospital | Berends F.J.,Rijnstate Hospital
Obesity Surgery | Year: 2011

Background: Recently, the laparoscopic sleeve gastrectomy (LSG) has become popular as a single-stage procedure for the treatment of morbid obesity and its co-morbidities. However, the incidence of micronutrient deficiencies after LSG have hardly been researched. Methods: From January 2005 to October 2008, 60 patients underwent LSG. All patients were instructed to take daily vitamin supplements. Patients were tested for micronutrient deficiencies 6 and 12 months after surgery. Results: Anemia was diagnosed in 14 (26%) patients. Iron, folic acid, and vitamin B12 deficiency was found in 23 (43%), eight (15%), and five (9%) patients, respectively. Vitamin D and albumin deficiency was diagnosed in 21 (39%) and eight (15%) patients. Hypervitaminosis A, B1, and B6 were diagnosed in 26 (48%), 17 (31%), and 13 (30%) patients, respectively. Conclusions: Due to inadequate intake and uptake of micronutrients, patients who underwent LSG are at serious risk for developing micronutrient deficiencies. Moreover, some vitamins seem to increase to chronic elevated levels with possible complications in the long-term. Multivitamins and calcium tablets should be regarded only as a minimum and supplements especially for iron, vitamin B12, vitamin D, and calcium should be added to this regimen based on regular blood testing. © 2010 The Author(s).


van Lommel P.,Rijnstate Hospital
Journal of Consciousness Studies | Year: 2013

In this article a concept of non-local consciousness will be described, based on recent scientific research on near-death experiences (NDEs). Since the publication of several prospective studies on NDEs in survivors of cardiac arrest, with strikingly similar results and conclusions, the phenomenon of the NDE can no longer be scientifically ignored. In the last thirty years several theories have been proposed to explain an NDE. The challenge to find a common explanation for the cause and content of an NDE is complicated by the fact that an NDE can be experienced during various circumstances, such as severe injury of the brain as in cardiac arrest to conditions when the brain seems to function normally. The NDE is an authentic experience which cannot be simply reduced to imagination, fear of death, hallucination, psychosis, the use of drugs, or oxygen deficiency. Patients appear to be permanently changed by an NDE during a cardiac arrest of only some minutes duration. According to these aforementioned studies, the current materialistic view of the relationship between consciousness and the brain as held by most physicians, philosophers, and psychologists is too restricted for a proper understanding of this phenomenon. There are good reasons to assume that our consciousness does not always coincide with the functioning of our brain: enhanced or non-local consciousness can sometimes be experienced separately from the body. © Imprint Academic 2011.

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